VOL. 10 No. 2 | May 2019

When surfing online forums, I have become accustomed to expecting the unexpected; however, coming across a website about new economic currencies, I was surprised to find a forum entitled ‘Medical Consult for Bitcoins.’ On this forum, individuals have written about their medical problems, agreeing to pay for medical advice posted in a response by a fellow member of the anonymous online community. Once receiving the advice, the ‘patient’ would then pay – not with Dollars, Euros, or even Groupons – but by ‘Bitcoin.’

‘Bitcoin’ is the name of the monetary unit within the world’s first fully online payment system or currency. A ‘bit’ is a unit of electronic information and ‘coin’ a measurement of value; it can be considered the ‘Dollar’ or the ‘Euro’ of the internet – virtual cash. Unlike in online poker games or Facebook Farmville trends, where money is exchanged temporarily for virtual dollars, individuals use and save Bitcoins for all kinds of real-world transactions, as a valuable, private, and permanent currency. Bitcoins make up the first currency based entirely on cryptography, rather than on validation from a centralized authority. This affords the currency a level of anonymity, safety, and privacy not found in any other currency – it is essentially untraceable. Bitcoins can also be easily converted into any international currency; the current exchange rate (as of May 23, 2013) for Bitcoin to dollars is approximately 1 Bitcoin (BTC) for $126.31009, or $1 for approximately 0.00791 BTC (Bitcoins can be split into fractions of up to 8 decimal places). In other currencies, 1 BTC = €98.00597 (Euros) and £83.61224 (British Pounds).

The opposition to expanding the use of Bitcoins mentions that there are risks of hacking; there are questions raised about whether individuals will be able to come up with the algorithms or technologies to steal Bitcoins or trace transfers. Thus far, no such issues have occurred. Other individuals question the stability of the Bitcoin, asserting that it has the possibility to bottom-out at any moment. Trends comparing Bitcoins to Dollars have shown a steady increase in value, and experts state that the Bitcoin’s value is expected to continue to increase.

Within the past year, there has been an interesting movement in healthcare brought about by the creation of Bitcoins. Bitcoins have created an under-the-table movement of individuals who post through aliases on online forums, promising sound medical advice in exchange for Bitcoins. Once the advice has been given, individuals transfer Bitcoins into the ‘practitioner’s’ account using a particular code, without either party having to divulge any kind personal identification. The practice of using Bitcoins shows interesting parallels with long-time trends found in rural medicine – using alternate currencies or goods to pay for medical services. Should doctors be open to accepting payments that take forms other than traditional currencies?

In theory, physicians should be able to decide the forms of payment they are willing to accept, as long as they are not unfairly raising prices for reasons regarding race, religion, gender, sexual orientation, political philosophy, or other personal biases. In practice, however, it is hard to regulate a system that compares 5 dozen eggs with an autographed baseball, .015 Bitcoins, a ticket to Disney World, and $80 in cash. Even with the best of intentions, using alternate forms of compensation can very quickly lead to ethical gray zones. If a physician values one form of currency over another, the doctor may be biased against patients who pay with other forms. Each form of payment would need to be evaluated for its ‘worth’ – intrinsic as well as socially constructed – to ensure fair practice.

In the past, Bitcoins have been used as remuneration during drug trafficking, gambling, and other illegal activities due to its security, privacy, and lack of traceability. Although Bitcoins are still in their infancy, when compared to other currencies, there seems to be promise of expansion – beyond the realm of illegal trading or even that of distasteful practice. More recently, Bitcoins have been adopted by ‘techies’ and modern day innovators for their qualities of being universal, secure, and private. Similarly, there is potential for the use of Bitcoins in more mainstream medicine. The security and privacy that Bitcoins afford, the characteristics that have made them so tempting for use in illegal trade and questionable practices, are actually qualities that all healthcare seekers hope for while receiving their medical care. Using alternate systems of remuneration for healthcare costs – whether small farming communities paying in chicken eggs and vegetables or internet techies paying in Bitcoins – raises important ethical concerns of justice and equity.

One response to “Doctor, a Bitcoin for Your Two-Cents?”

Just found your blog. Interesting though it is, I am not sure Bitcoin naturally leads to “ethical gray zones”… At least not any more than cash, which does not carry the same charges and fees as credit cards.

Furthermore, I still have the scrapbook my father kept from his days as a Doctor in Mississippi in the 50’s. Being paid in chickens and eggs wasn’t uncommon, and I don’t see how he was ethically compromised when he accepted such payments. The scrapbook is full of letters written appreciating his care and kindness, and promises of a ham in December to pay for the delivery of a baby.

Dollars are the currency of choice for the illegal drug trade. Estimates put the drug trade in the US to be at least 100 billion dollars. The Government only claims to seize 1 billion per year, meaning drug traffickers are paying less in transaction costs than the typical doctor using a credit card. If illegal trade is an ethical concern somehow, then Doctors should quit accepting dollars.

I guess what I am asking is, what are these “ethical concerns of justice and equality” that you are claiming are raised? How do they differ from paying in cash? And what about the justice and equality issues raised by accepting insurance payments?

#Bioethics News: In its decision to approve two drugs for orange and grapefruit trees, the E.P.A. largely ignored objections from the C.D.C. and the F.D.A., which fear that expanding their use in cash crops could fuel antibiotic resistance in humans. https://t.co/9hAvsohLvB